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Fluids, Respiratory, Muscles > Respiratory Examination > Flashcards

Respiratory Examination Flashcards

1
Q

What breed of dog is laryngneal paralysis more common in?

A

labrador retrievers

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2
Q

What might be risk factor for respiratory disease

A

obesity

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3
Q

What can you do if you have a cow in urgent respiratory distress with stridor noises (signs of upper airway problem)

A

open the trachea

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4
Q

What are some possible clinical signs of upper respiratory issues

A

Stertor
Stridor
Inspiratory dyspnea
submandibular lymph node enlargement
unilateral nasal discharge
cough elicited on laryngeal palpation

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5
Q

Is inspiratory dyspnea seen with upper or lower airway disease

A

upper

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6
Q

Is expiratory dyspnea seen with upper or lower airway disease

A

lower

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7
Q

What are the clinical signs of lower airways disease

A

-Expiratory dyspnea
-Abnormal lung auscultation and/or thoracic percussion
-bilateral nasal discharge

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8
Q

Do you typically see bilateral nasal charge is upper or lower airway disease

A

typically with lower airway disease but do not rule out upper if if you bilateral nasal discharge

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9
Q

increased respiratory rate due to hypoxemia, hypercapnia, metabolic acidosis, hyperthermia

A

tachypnea

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10
Q

labored breathing
term is often subjective, often included abnormal breathing pattern, nasal flaring, abduction of elbow, extension of head

A

dyspnea

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11
Q

tachypnea

A

increased respiratory rate due to hypoxemia, hypercapnia, metabolic acidosis, hyperthermia

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12
Q

dyspnea

A

labored breathing
term is often subjective, often included abnormal breathing pattern, nasal flaring, abduction of elbow, extension of head

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13
Q

What are potential causes of animal in respiratory distress

A

1) Upper airway obstruction- respiratory noise audible
2) Lower Airway obstruction- pronounced expiratory effort - abdominal effort
3) Pleural space disease- decreased/absent lung sounds
4) Pulmonary parenchymal disease- increased/abnormal lung sounds

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14
Q

What would you see on physical exam of an animal in respiratory distress due to upper airway obstruction

A

respiratory noise is audible

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15
Q

What would you see on physical exam of an animal in respiratory distress due to lower airway obstruction

A

Pronounced expiratory effort

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16
Q

What would you see on physical exam of an animal in respiratory distress due to pleural space disease

A

decreased or absent lung sound

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17
Q

What would you see on physical exam of an animal in respiratory distress due to pulmonary parenchymal disease

A

increased/ abnormal lung sounds

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18
Q

How do you clinical examine the respiratory system

A

1) Respiratory rate
2) Respiratory effort
3) Respiratory pattern
4) Respiratory pattern
5) Cough sneeze, rattle
6) Air flow
7) Nasal discharge
8) Sinus percussion
9) lymph nodes
10) Palpation and auscultation of trachea
11) Rebreathing exam

*Does not only consist of lung auscultation

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19
Q

T/F: respiratory evaluation only includes lung auscultation

A

False

1) Respiratory rate
2) Respiratory effort
3) Respiratory pattern
4) Respiratory pattern
5) Cough sneeze, rattle
6) Air flow
7) Nasal discharge
8) Sinus percussion
9) lymph nodes
10) Palpation and auscultation of trachea
11) Rebreathing exam

*Does not only consist of lung auscultation

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20
Q

What should you look for when evaluating the nostrils in a respiratory exam

A

1) Assess nostril for discharge (serous, epistaxis, mucopurulent)
-present or absent
-unilateral (Upper) or bilateral (Lower)
-quality of discharge
-odor of discharge

2) Assess nostrils for airflow
-Present of absent

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21
Q

What might be an exception to upper airway disease having unilateral nasal discharge

A

horse with guttural pouch mycoses might have hemorrhage and bilateral nasal epistaxis

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22
Q

What is a dynamic obstruction

A

a respiratory noise that only occurs during inspiration OR expiration

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23
Q

a dynamic obstruction is respiratory noise that only occurs during

A

inspiration or expiration

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24
Q

What is a fixed obstruction

A

a respiratory noise that occurs during inspiration and expiration

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25
Q

T/F: loudness can be used to grade the degree of obstruction

A

False- a loud noise does not mean it is a severe obstruction

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26
Q

What is the difference between stertor vs stridor

A

‘Stertor’ is noisy breathing which occurs rostral to the larynx. ‘Stridor’ is noisy breathing that occurs at the level of the larynx or caudal

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27
Q

What classical cause of a horse having an inspiratory and expiratory noise during exercise

A

laryngeal paralysis

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28
Q

altered vocalization typically caused by diseases that affect the vocal cords

A

abnormal phonation

vocal cord paralysis (CN X), inflammation, infection, physical deviations due to tumors, cysts, etc

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29
Q

what is often one of the earliest signs of vocal cord disease

A

altered phonation

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30
Q

When does cyanosis occur

A

Un-oxygenated hemoglobin (>5g/dL)

O2 saturation <80%
PaO2 <40mmHg

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31
Q

What are the only lymph nodes that can be easily palpated in the healthy horse

A

Submandibular lymph nodes- located at the intramandibular space

*The retropharyngeal lymph nodes may be palpated if enlarged

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32
Q

Submandibular lymph nodes- located at the intramandibular space are the only lymph nodes that can easily be palpated in the healthy horse, but what else can you palpate if they are enlarged

A

the retropharyngeal

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33
Q

What is the importance of palpating the (sub)mandibular lymph nodes for respiratory examination

A

lymph nodes get antigens from the head, oral cavity, nasal cavity, eyelids, and paranasal sinuses.
can help tell you possible causes

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34
Q

What is the importance of paranasal sinus percussion in large animals

A

you want to compare the resonance on both sides and if the horse seens painful
also want to see how the animal responds? are they painful from this pressure

*Is it fluid filled (dull) or air filled (hollow) sounding

35
Q

Why is it important to percuss the caudal maxillary sinus in a horse

A

sinusitis commonly affects this sinus because of tooth root problems of the last premolar and molar

36
Q

What is the most common place for a cow to develop sinusitis

A

Frontal sinus

*dehorning or horn problems

37
Q

How should you examine the larynx

A

1) Palpate dorsal aspect of larynx noting any asymmetry
2) Palpate retropharyngeal area for retropharyngeal lymph node enlargement
3) Slap test (horse): put finger around larynx of horse and slap withers to elicit a twitch of the musculature
4) Try to elicit a cough- squeeze trachea after larynx and if they cough there is some degree of laryngeal sensitivity

38
Q

What is the slap test of the horse?

A

Slap test (horse): put finger around larynx of horse and slap withers to elicit a twitch of the musculature
tests recurrent laryngeal nerve (CN X)

39
Q

What is the significance of trying to elicit a cough during a respiratory exam

A

Try to elicit a cough- squeeze trachea after larynx and if they cough there is some degree of laryngeal sensitivity

40
Q

How should you examine the trachea

A

1) palpate the trachea for any abnormalities such as irregular cartilage rings or fractures
2) Auscult the trachea for any abnormal sounds (mucous rattles)

41
Q

Why might an animal have subcutaneous emphysema

A

caused by disruption of the respiratory tract distal to the larynx
e.g tracheal rupture or perforation, penetrating foreign body, iatrogenic

42
Q

caused by disruption of the respiratory tract distal to the larynx
e.g tracheal rupture, penetrating foreign body, iatrogenic

A

subcutaneous emphysema

43
Q

What is a normal breathing pattern

A

Costoabdominal breathing
respiratory effort is split equally betwee the chest and abdomen

44
Q

Costoabdominal breathing

A

respiratory effort is split equally betwee the chest and abdomen

*normal breathing

45
Q

What might be happening if the animal has increased thoracic effort of breathing

A

pain the abdomen

46
Q

What might be happening if the animal has increased abdominal effort of breathing

A

lost of elasticity of lungs

47
Q

Normally, the breathing pattern is split between chest and abdominal efforts. What happens if this isnt equal

A

Increased Thoracic effort: pain the abdomen

Increased abdominal effort: lost of elasticity of lungs

48
Q

What might be happening if a horse has increased abdominal effort (recruitment of accessory muscles during expiration)

A

some sort of lost of elasticity of lungs

*Increased expiratory
chronically might result in heaves line due to hypertrophy of abdominal muscles

49
Q

What might be happening if you see a cat that has increased abdominal effort and restrictive breathing pattern

A

reduced chest wall/ lung compliance having to use abdominal muscles to breathe

pleural effusion?

50
Q

Breath sounds are created by

A

turbulent airflow

occurs when high velocity flow passes through a large diameter airway

51
Q

when is laminar breath flow generated

A

occurs in low flow situation (small airways <2mm)

not enough air movement to generate turbulent sound

52
Q

When is turbulent airflow generated

A

occurs when high velocity flow passes through a large diameter airway

53
Q

Airflow turbulence is determined by

A

1) Airflow velocity
2) Airway lumen architecture

54
Q

What increases the airflow turbulence

A

1) Decreases in the cross sectional area (at equal volume) increases airflow. velocity

2) Irregular lumen architecture: increases airflow turbulence

55
Q

How should you auscultate at rest

A

-Compare sounds in ventral, dorsal, and mid thorax
-Compare sounds ausuculted in the left and right thorax
-Compare lung osunds to tracheal sounds

56
Q

What is the purpose of a rebreathing exam

A

uses a plastic bag around nose in horses

allows auscultation of subtle airway sounds because the horse will begin to breathe more heavily and the sounds will become more apparent

allows assessment of recovery time

allows assessment of coughing

57
Q

What does the intensity of breathe sounds depend on

A

1) Amount of turbulence (airflow velocity and airway lumen architecture)
2) Acoustic characteristics of tissue
3) Thickness of tissue

58
Q

During tracheal breath sounds, you hear

A

inspiratory and expiratory sounds are equal (very loud and high pitch)

*over the trachea

59
Q

During bronchial breath sound, you hear

A

inspiratory sound is shorter than the expiratory (loud, relatively high pitch)

60
Q

During bronchovesticular breath sounds, you hear

A

inspiratory and expiratory sounds are equal (medium loudness, intermediate pitch)

*first and second intercostal spaces next to sternum

*same as tracheal but not as loud because it has to travel through more tissue

61
Q

During vesticular breath sounds, you hear

A

inspiratory sound is longer than the expiratory sound (soft, relatively low pitch)

most of the lung field

62
Q

What are factors of impaired sound transmission during a respiratory exam

A

1) Extrapulmonary factors
a) chest deformities
b) Obesity

2) Intrapulmonary factors
a) Disrupted mechanical properties of lung (emphysema)
b) Addition of medium between lung and sthethoscope (air, fluid, masses)

63
Q

What might be extrapulmonary factors of impaired sound transmission

A

a) chest deformities
b) Obesity

64
Q

What might be intrapulmonary factors of impaired sound transmission

A

a) Disrupted mechanical properties of lung (emphysema- more air in tissue)

b) Addition of medium between lung and stethoscope (air, fluid, masses)

65
Q

How does lung consolidation affect lung sounds

A

Normally the lung is aerated where sound must move through multiple air-tissue interfaces

however, when the lung is consolidated with patent airways, there are fewer air-tissue interfaces leading to less attenuation and increased intensity

when there is consolidated lung with blocked airways, there is loss of breathe sounds

66
Q

How does consolidated lungs affect airsounds

A

when the lung is consolidated with patent airways, there are fewer air-tissue interfaces leading to less attenuation and increased intensity

when there is consolidated lung with blocked airways, there is loss of breathe sounds

67
Q

What are adventitious lung sounds

A

additional respiratory sounds superimposed on normal breathe sounds
1) Wheeze
2) Crackles
3) Stridor
4) Pleural friction rub
5) Squawk

68
Q

What are the 5 adventitious lung breathe sounds

A

1) Wheeze (continuous, melodic, high or low pitch)
2) Crackles (interrupted, musical, high or low pitch)
3) Stridor (continuous or interrupted, musical, high pitch)
4) Pleural friction rub (interrupted, non-musical)
5) Squawk (mixed sounds- short wheeze, squeak)

69
Q

turbulent flow through narrowed segment of the upper respiratory tract
*inspiratory

A

Stridor

70
Q

What is Stridor

A

turbulent flow through narrowed segment of the upper respiratory tract
*inspiratory

71
Q

Stridor that originates from the airway rostral to larynx

A

Stertor

72
Q

long and musical sound
high or low pitched
may be expiratory or inspiratory
due to narrowing of airway

A

Wheezes

72
Q

noise that results from vibration of the pharyngeal tissues (nasopharynx, oropharynx, soft palate) due to significant upper respiratory obstruction and subsequent turbulent airflow downstream in the upper airway. This is a noise heard only on inspiration.

A

Stertor

73
Q

What produces the wheezes sound

A

narrowing of the airway

74
Q

T/F: wheezes are only heard during expiratory

A

false- may be heard due inspiration or expiration

75
Q

short, explosive, nonmusical heard on inspiration due to sudden inspiratory opening of small airways

A

Crackles

76
Q

When are crackles heard

A

due to sudden inspiratory opening of small airways

77
Q

How do you perform thoracic percussion

A

place middle finger in the intercostal space and knock finger against chestwall. Do you hear differences between the top or bottom (where fluid might be in the pleural space)
can also use spoon and hammer

normal lung: clear, moderate intensity, low pitch

78
Q

Is thoracic percussion the most sensitive technique to detect fluid in the chest?

A

No- ultrasound is the best method

79
Q

What would trapped air (eg. pneumothorax) sound like on thoracic percussion

A

clear quality, loud intensity, low pitch

80
Q

What would solid tissue (eg. pleural effusion consolidation or mass) sound like on thoracic percussion

A

dull quality, soft intensity, high pitch

81
Q

Airflow turbulence (cause of breath sounds) are determined by

A

1) Airflow velocity
2) Airway lumen architecture

82
Q
A

Fluids, Respiratory, Muscles (7 decks)

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